Meds

A domperidone dilemma: A patient’s perspective on ordering from Canada

Meds
March 5, 2015

Three years ago I received some of the best news of my life — that I have dopa-responsive dystonia. (Yes, a neuromuscular disorder was welcome news.) Painful, life-interrupting muscle contractions had made the dystonia diagnosis likely several years before, despite poor response to standard treatments, and I was fighting through graduate school: trying to compensate for medication-induced memory problems, increasing need to work from bed, and a disappearing social life. …

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Ask for Dilaudid, get Dilaudid. No questions asked.

Meds
February 28, 2015

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A local hospital is trying a new, controversial but more efficient approach to medical care. “We have changed our guidelines, if you want Dilaudid you get Dilaudid, if you want Valium, you get Valium. No questions asked,” CEO Michael Shoemaker told reporters Wednesday.

In what experts are calling pure genius, emergency …

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How the advent of propofol changed the meaning of the term “sedation”

Meds
February 19, 2015

“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!”

We were in the preoperative area of my hospital, where my patient — brightly alert, with a colorful headband and bright red lipstick — was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, …

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The truth about Miralax in children

Meds
February 12, 2015

Parents are appropriately expressing concern about the safety of Miralax®, a commonly used stool softener in kids, after a recent New York Times article exposed a potential association with long-term use of the drug and undesired behavioral side effects. As the article explains, the FDA has awarded a research grant to a team at the Children’s Hospital of Philadelphia (CHOP) to directly address these concerns.

Miralax® has been used …

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Scared of the flu vaccine? Let’s see what’s really inside it.

Meds
January 14, 2015

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Dangerous ingredients, like toxins, antifreeze, and mercury, are touted by many as reasons to decline vaccination against influenza. However, toxin is an inaccurate term regarding vaccines (a toxin is a poisonous substance made by cells or organisms and is definitely not in any vaccine), mercury is a non-issue (see below), and there is no antifreeze in vaccines (although some contain propylene glycol, …

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Why do drugs cost so much?

Meds
November 12, 2014

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Drug prices are a difficult issue to write about because real data about the workings of pharmaceutical companies is very difficult to uncover. Still, I came face to face with something that seemed extremely not right and so I feel I should at least make some comment. It started when I prescribed a patient sumatriptan for her recently more frequent migraines. …

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The era of trial and error medicine needs to be over

Meds
November 7, 2014

We always want to get it right the first time when treating patients, but the truth is this is difficult. When there is uncertainty of disease course and prognosis, multiple treatment options, and variable responses to therapy this becomes even more challenging.  Our typical strategy to making it “just right” isn’t too different from Goldilocks. We have mild treatments (too cold), and aggressive treatments (too hot), and even in the …

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Why your doctor won’t refill prescriptions over the phone

Meds
October 13, 2014

Giving prescription refills is not quite as fun as it used to be. Years ago, we doctors would whip out our prescription pads — often sooner than we should have — and we’d scribble some coded language that pharmacists were trained to decipher. I’m surprised there were not more errors owing to doctors’ horrendous penmanship. On occasion, the Food and Drug Administration (FDA) would require a pharmaceutical company to change …

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7 common reasons for refusing vaccines

Meds
October 3, 2014

The Centers for Disease Control and Prevention (CDC) reported that between January 1 and May 23 of this year, there were 288 cases of measles reported in the US. That’s more than the total number of cases in any year since 2000, when measles was eliminated in the U.S..

We have got to get more people immunized.

Essentially all of the cases were linked to “importations,” cases brought in from other countries …

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Are you a medical liberal or a conservative?

Meds
August 9, 2014

Our nation is highly polarized today, and often bitterly so.  Democrats rail against the GOP.  Pro-lifers face down pro-choicers.  Fox News disses MSNBC.  Isolationists push back against expansionists.  Traditionalists disdain the politically correct.  Free marketers duel against government advocates.  Carnivores deride the gluten-free crowd.  Martin Bashir trashes Sarah Palin, two proxies in a culture war.

There’s a philosophical divide among physicians also.  Would you prefer a liberal physician or a conservative …

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Why are doctors still prescribing Zetia?

Meds
July 10, 2014

A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia.

This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined …

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The problem with an anti-medication bias

Meds
June 6, 2014

“I don’t like taking medicines.”

All physicians hear some form of this opinion very frequently. Even more frequently, patients don’t state this view outright but rely on it to completely subvert their doctor’s plans.

When I was new to practice such an utterance would shock and confuse me.

“I don’t want to take any medicines,” a patient would declare.

“That’s fine,” I would reassure my interlocutor. “It’s a free country. No one is going …

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What do European doctors say about our guidelines for statins?

Meds
April 23, 2014

In November of last year the American Heart Association released to recommendations on who should be taking statins (drugs like Lipitor/atorvastatin), the most common medicines we use to control cholesterol levels. High cholesterol levels are associated with higher risk of heart attacks and strokes, and taking statins, which lower cholesterol, can reduce those risks. The drugs have pretty significant side effects, though, and not everyone with high cholesterol or …

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Understanding the uproar over Zohydro ER

Meds
March 30, 2014

In March 2014, Zohydro ER (hydrocodone extended-release) was introduced to the market. Never in my medical lifetime do I recall a medication stirring such angst. Worries of mass overdoses, backdoor FDA conspiracies, and blatant disregard for the public well-being abound. Is there method to this madness?

Zohydro ER is a pain pill that, when taken by mouth, is released slowly over twelve hours. The active ingredient, hydrocodone, is an opioid (i.e. narcotic) that’s been around for decades …

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The societal problem of opioid addiction

Meds
March 6, 2014

Opioids are a family of pain medications chemically related to opium and heroin. They include morphine, fentanyl, codeine, hydromorphone and others. Opioids have unique properties that make them both indispensable for pain management and extremely dangerous.

Unlike virtually any other family of medications, opioids have no maximum effective dose. If any dose, no matter how high, is ineffective at controlling pain, a higher dose can give more pain relief. Most other …

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Proton pump inhibitors and B12 deficiency: What to do now

Meds
December 19, 2013

We can now add vitamin B12 deficiency to the growing list of risks of long term use of the proton pump inhibitors (PPIs).

The New York Times had an article outlining the evidence that prolonged use of both proton pump inhibitors (PPIs) like Prilosec, Protonix, Prevacid and others, as well as the less potent H2 blockers like Zantac and Pepcid, can lead to vitamin B12 deficiency.  This is in addition …

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Standardize drug names and reduce the risk of medication errors

Meds
December 5, 2013

Ever get confused over the names of medicines?

I do.

There’s Zantac and Xanax. Zanaflex and Zaleplon.

But Zanaflex is also known as tizanidine. Tizanidine functions very differently than Zantac and its other name, ranitidine, even though they sound alike.

Every drug has (at least) two names — one proprietary, and one generic. Proprietary names are created to sound catchy by the original manufacturer, almost always under a patent. The generic names are more like chemical …

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How to know whether antidepressants will help

Meds
November 18, 2013

It seems to be trendy these days to say we’re all overmedicated. People say we  swallow a pill to try to escape any fleeting negative feeling, or that we throw them at our kids for any bad behavior. To be honest, there are times I agree.

However, sometimes people take the anti-medication thing way, way too far. They say antidepressants are a conspiracy of the drug companies to make us all …

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The truth about guar gum

Meds
July 4, 2013

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It is increasingly difficult to find real ice cream.  When reading the ingredient list it is discouraging how many cheap fillers, consistency modifiers, and shelf life extenders are included.  One ingredient, namely guar gum, seems fairly ubiquitous.  So what is guar gum, and why is it found in so many products including ice cream?  Is it “bad” to eat?

Guar …

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Herbal medicine: 6 tips to consider when talking to your patients

Meds
July 4, 2013

Herbal medicines make most doctors cringe, laugh, or want to put blinders on and pretend they don’t exist. This is understandable. While allopathic medical education hammers pharmaceutical formulas and mechanisms of action into our brains, we learn little-to-nothing about herbs in medical school. Quite the opposite – we are most often told to uniformly discourage our patients from taking herbs out of concern for safety; a conversation stopper with little …

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